Sex Therapy: How It Works

This is the second part of our interview with sex therapist Sarah Young, who works with individuals and couples to help them rediscover--or perhaps discover for the first time--the joys of sex.

Q: At what point does the woman’s partner usually get involved?

A: Usually, I work with a woman for about a month before bringing in her partner. At that point, I try to get a feel for where he’s coming from, whether he wants to meet individually. If he does, we might move ahead where every other session is with the couple--so it’s couple, individual, couple, individual, through the duration of the therapy.

Q: What are some of the therapy techniques you use with couples?

A: We have many techniques, but if we need to talk about the basics, such as specific sexual positions and so on, I have these two little pipe cleaner people. The little blue person with the erection represents the man, and the pink one, with little boobs, is the woman. It’s delightful because some people have a problem even looking at pictures, so it’s a very neutral way to teach people positions.

I’ll also suggest readings, and we use a lot of sensate focus, too, which is kind of the default “go-to” for sex therapy in terms of reintroducing touch to couples. They rediscover the joy of just looking at each other, or sitting together, or holding each other. That also gives the therapist some control to say, okay, I’m going to take over your sex lives for awhile. You don’t have to worry about whether you should be doing this or doing that. You just have to do this one exercise, and it’s not even going to involve your genitals.

Because sex is not just about orgasms; it’s not just about his erect penis and your lubricated vagina. If that’s how it’s framed for couples, they’re doomed for failure. But if they can broaden their definition of the sexual experience, it’s huge for them in terms of being allies in the bedroom, on the same team, saying, this stage of life can be fabulous, how can we really embrace it?

Q: Can you give an example of a successful case involving a husband and wife?

A: There was a woman who came to see me because she wasn’t enjoying sex; for her entire married life it had been, “Okay, let’s just get this over with…” Come to find out, when she was a little girl, she was experimenting with masturbation, as kids often do. Her mother, who was very uptight about sex, discovered her and flipped out, making her filled with shame and guilt over it.

First we had to deal with her wounds, dissolving some of the lies she believed and getting her to see her sexuality from an adult perspective, rather than through the eyes of a seven-year-old.  We talked about how a person’s sexuality is not just limited to the bedroom; it’s part of who you are every day. I gave her some exercises to increase her confidence. For instance, a lot of women will look in the mirror and just see sagging boobs and cellulite. But I had her stand in front of the mirror and take joy in her hands, the hands that had held her children and made food for her family. And instead of keeping her sex drive on a low boil, I told her to go get some red underwear to remind herself that she’s a beautiful, sexual woman who has a right to enjoy and to be enjoyed by her husband. So it was getting her to see things in a new way, as an adult.

Over a period of time, she began to gain confidence, becoming more mentally present with him in the bedroom. And it just kind of took off from there. She’s still working on not feeling uptight, but she’s doing really great.

Q: Your work must be very satisfying. Do you enjoy it?

A: I absolutely love it; to see the hope in a woman’s eyes when she finds out she’s not crazy or abnormal or to see a husband who feels like he’s got his wife back, it’s just the best thing.

Sex Therapy: Not So Scary after All!

A few months ago we talked about couples therapy, which caused some discussion about a closely related field: sex therapy. The idea of going to a sex therapist may be so scary that you wouldn’t even consider it! You’re probably not alone. That’s why we decided to talk with Sarah Young, MA, who is a sexual therapy specialist whose practice is Christian-based.

Sarah was educated at the Institute for Sexual Wholeness in Atlanta; her philosophy is that sex is not just sacred, it’s meant to be enjoyed. “It’s still such a taboo issue,” she says. Her goal is to help people find a “voice” for their sex lives, to talk about it and explore it freely without shame or guilt. She had so many interesting things to say, we’ve divided the information up into two parts; here, she talks about getting started:

Q: What’s the biggest “fear factor” or misconception women have about sex therapy?

A: Sex is such a personal, intimate thing. They’re afraid they’re going to have to get naked and perform: Oh, my gosh, am I going to have to take my clothes off and show her what we do? That’s not how it works at all.

Q: Let’s talk about how it does work: How do you get started?

A: A lot of my referrals come from doctors working with women, so I’ll usually start with the woman. We’ll just have a conversation at first. Patients often ask how I got into sex therapy, and that gives me the opportunity to establish my professionalism, my ethics, and how I feel about the sacredness of sex, which always makes them feel more comfortable.

Then we’ll begin by talking about the bigger picture, her world as a whole: What are her other life stressors? I need to get an idea of everything that’s going on in her life, the larger dynamic, because it’s all entwined in the bigger circle. It’s not, Okay, give me all the details and let’s go.

Facing failure goes against what Hollywood says your sex life should be; it’s very threatening for people. So I try to validate her in that first session ­— here’s where you are and this is fine — and to offer her hope.

Then in the second session, I’ll usually engage in a pretty in-depth sexual history just to find out where she’s coming from. What are her automatic thoughts, how has her body image been formed, and what other experiences are in her reality? Some of the questions are very difficult for people, like whether she is masturbating, and if so, how often.

Once we uncover all the issues, we’ll talk about a game plan. At that point, I usually give it three weeks to a month between sessions, so they can just go through a cycle of life. Because you need to give this time; one week you might have a hormone issue, the next week, everything is okay. You need that whole cycle to give it a framework.

Q: What kinds of issues do you typically deal with in older women?

A: One big thing, of course, is menopause and all the changes that come with it. Women sometimes feel defective when they’re going through it, which is understandable. Often it’s a matter of shifting their perspective to just normalizing it; it is what it is, you need to take it one chunk at a time.

Other issues might be aging in general, or a partner’s infidelity, or the reality of cancer and mastectomies: How am I still supposed to feel sexy when my breasts are gone? And the empty nesters: The kids have gone off and mom and dad haven’t paid attention to each other for years. Now all of a sudden, she’s thinking, I don’t even know how to be his friend, let alone his lover. So a lot of it is empowering people to reignite the passion and the friendship they once had; they’re in a place when they can engage in a more mature perspective.

Q: Once a person starts therapy, how long might it last?

A: It really depends… I have couples I’ll see every few weeks for three months and they’ll check in after that every few months to update, or if they’ve hit a glitch or want to talk through it. Every case is different, really.

Watch for part two of Sarah’s interview, in which we discuss partners’ roles and therapy techniques used; you can see it next week!